Proposed changes to the Foundation Programme in England will help specialties and regions that need more doctors while also supporting doctors from a wider range of backgrounds, Health Education England (HEE) has pledged. The British Medical Association (BMA) has broadly welcomed the review’s proposed improvements to flexibility and educational support, but it also insisted that there must be no reduction in junior doctors’ ability to choose fairly where to train, and that a potentially “valuable” mentoring scheme must not be allowed to replace good quality clinical supervision.
HEE’s review took a detailed look at the Foundation Programme in England and considered what improvements could be made to offer the best possible training experience. The resulting report Supported from the start; ready for the future proposed that HEE would:
- Promote specialties and areas of the country where more doctors are needed, with incentives to encourage trainees to choose to train in them;
- Distribute new foundation doctor training places in the geographical areas where they are needed most, in alignment with regional plans;
- Create a common framework for early years career support to tie with the NHS People Plan and better inform doctors in training’s expectations about the changing needs of the NHS in England;
- Work with NHS Employers to develop a foundation doctor charter setting out how local education providers will support foundation training including best practice and minimum standards;
- Support trainees, employing trusts and trainee supervisors to ensure that high quality supervision is being consistently delivered in the interests of patient safety and quality of care; and
- Launch a formal consultation to explore what can be done to best support doctors from a wider range of backgrounds once they join the foundation programme.
The BMA said it welcomed the review’s positive recommendations, including “much-needed” improvements in access to less than full-time training training and flexibility of working percentages, support for doctors before, during and after the Foundation Programme, and enhanced access to early years careers support, as well as HEE’s commitment to further work on widening participation, improving pre-allocation panels for trainees with special circumstances and rostered time for professional development. But it added: “Innovative approaches to improve staffing in under-doctored areas are to be welcomed, although there is still much more to be done to improve working conditions in these locations. It is also important that any changes made do not reduce the ability for junior doctors to choose where to train through a fair, transparent and equitable system.”
And it warned: “While the opportunity for more of a role for senior trainees in mentoring foundation doctors could be valuable for those involved, investment must be made in both time and training for this to be effective, and it cannot be a replacement for good quality educational supervision.”
The BMA Junior Doctors’ Committee chair of education and training, Dr Sarah Hallett, said the proposals – if enacted – have the potential to make a significant difference to the lives of future trainee doctors. She commented: “With the NHS continuing to battle a retention and recruitment crisis, it is vital that junior doctors are given the best possible support before, during and after the foundation programme, which represents their first step into a career in the health service.
“Proposals such as improving access to training and flexibility of working percentages for doctors who are less than full-time are long overdue but very welcome; similarly a move to provide dedicated time for professional development would have an instant positive impact on junior doctor work-life balance.
“While innovative approaches to improve staffing in areas with fewer doctors are necessary, the introduction of Foundation Priority Programmes must not reduce the ability for trainees to choose where they train, nor replace efforts to improve working conditions in these areas.
“These recommendations do not necessarily mean that change will be immediate, however, the BMA will continue to engage with this work to ensure trainee doctors of the future ultimately benefit from the positive steps set out in this report.”